Malta is among the top six EU countries with the highest private spend on health - 31% of total health expenditure - the majority of which is paid out of pocket.

The Euro Health Consumer Index scored the country exceptionally well on access to healthcare, health spending, and range of services offered, but excessive waiting times were identified as one of the main reasons why so many Maltese choose to pay out of pocket and seek private treatment when they could get most treatments for free through the public health service.

The ECHI for 2017, an independent report drawn up by Health Consumer Powerhouse (HCP), notes that these out-of-pocket direct payments, as a share of total health expenditure, totalled 29%, significantly higher than the EU average of 15%. Out-of-pocket spending, in fact, accounts for 5% of total household final consumption, which is the second highest in the EU.

The report says that if Malta is ever to cut its waiting lists for health services, it should look to what other small countries in the European Union are doing. It highlights how Slovakia has radically improved access to treatment, how tiny players such as Macedonia and Montenegro have used e-health to abolish patient waiting and how low-key Finland climbs in the Index year by year.

Healthcare is basically a process industry, and as any professional manager from such an industry would know, smooth procedures with a minimum of pause or interruption are key to keeping costs low.

If countries with limited means can achieve virtual absence of waiting lists – what excuse can there be for countries like Malta to keep having waiting list problems?

Malta was ranked in 23rd place overall in the EHCI, with 642 points out of a possible 1,000. The report notes that Malta enjoys decent accessibility, but is not too strong on treatment results.

“There seem to be gaps in the public subsidy system of Maltese healthcare,” HCP says. “This is particularly prominent for drug subsidies; many Maltese do not bother with receiving a subsidy. The result is that Malta has little data on drug use.”

The EHCI notes that in spite of financial crisis-induced austerity measures, such as the much publicised restrictions on the increase of healthcare spend, European healthcare keeps producing better results.

Survival rates of heart disease, stroke and cancer are all increasing, even though there is much talk about worsening lifestyle factors such as obesity, junk food consumption and sedentary life. Infant mortality, perhaps the most descriptive single indicator, also keeps going down, and this can be observed also in countries such as the Baltic states, which were severely affected by the financial crisis.

Life expectancy in Malta is high and the population spends an average 90% of their lifespan in good health, longer than in any other EU country. The health system provides universal coverage and access to a comprehensive set of services.

New public-private partnerships aimed at increasing capital investment and quality of care are changing the role of the Ministry of Health from a pure provider to that of provider and contractor of services.

Health spending has increased steadily since 2005, up to €2,255 per capita on health care, compared to the EU average of €2,797. This equals 8.4% of GDP, below the EU average of 9.9%.

Paul Cocks joined MaltaToday after having spent years working in newspapers with The Times...